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1. An Observational Cohort Study to Evaluate the Impact of a Tailored Medicines Optimisation Service on Medication Use, Accident and Emergency Department Visits, and Admissions Among Patients Identified with Medication Support Needs in Secondary Care

Author

Harrap N, Wells J, Howes K, and Kayyali R

Subjects
medicines optimisation, admission, medication adherence, social care, polypharmacy, Medicine (General), R5-920
Abstract

Nicola Harrap,1 Joshua Wells,1 Katherine Howes,2 Reem Kayyali1 1Department of Pharmacy, Kingston University, Kingston, KT1 2EE, UK; 2Lewisham Integrated Medicines Optimisation Service, Pharmacy Department, Lewisham & Greenwich NHS Trust, London, SE13 6LH, UKCorrespondence: Reem Kayyali, Department of Pharmacy, Kingston University, Penrhyn Road, Kingston, KT1 2EE, UK, Tel/Fax +44 208 417 2561, Email r.kayyali@kingston.ac.ukPurpose: Quantifying the impact of pharmacy interventions, such as tailored medicines optimisation, can be challenging owing to the sometimes-indirect nature of their effect on patient outcomes such A&E (Accident & Emergency) attendance, hospital admission and length of stay. This study aimed to assess the impact of the, Lewisham Integrated Medicines Optimisation Service (LIMOS) on medicines self-management, A&E attendances and hospital admissions.Patients and Methods: The study was conducted as a retrospective and prospective observational evaluation of patients referred to LIMOS at University Hospital Lewisham between April and September 2016. Only patients with an appropriate referral that received a LIMOS intervention within the study period were considered eligible. The main outcomes examined pre- and post-LIMOS included medicines self-management, A&E attendance, number of admissions, as well as length of stay.Results: Data were collected for a total of 193 patients. Over half (56.4%, n = 109) identified as female with a mean age of 78 years at the time of referral. The number of hospital admissions decreased significantly post-LIMOS (− 0.36 ± 1.87, 95% CI − 0.63– 0.10). Furthermore, the mean reduction in length of stay was significant and decreased by over a week (19.58 vs 11.09 days post-LIMOS, − 7.67 ± 48.57, 95% CI − 14.57–− 0.78). There was a significant increase in A&E visits observed post-intervention (0.78 ± 1.93, 95% CI 0.50– 1.06); however, the majority (63%, n =165/261) occurred over 90 days post-intervention. There was a significant reduction in the number of patients self-managing medication post-LIMOS, with the number of patients receiving additional support with their medication increasing (− 0.38 ± 0.50, 95% CI − 0.45–− 0.31). LIMOS, therefore, successfully identified patients who were unable to manage their medicines.Conclusion: Specialist pharmacy interventions, which include support with medicines management, have a positive impact on admission avoidance and length of hospital stay.Keywords: medicines optimisation, admission, medication adherence, social care, polypharmacy

Published
2022

8. Exploiting macrofauna diadromy for assessing anthropogenic impact in American Samoa streams (1)

Author

Wade, L.M., Fanolua, F.S., Vargo, A.M., van Houte-Howes, K., Bardi, E., and Vargo, D.L.

Subjects
Water quality -- Research -- Methods, Stream fauna -- Distribution -- Influence -- Varieties -- Methods -- Research, Biological monitoring -- Methods -- Research, Stream ecology -- Research -- Methods, Rivers -- Properties -- Methods -- Research, Company distribution practices, Earth sciences, Science and technology
Abstract

Abstract: Stream biomonitoring is increasingly used to identify and monitor changes in water quality, stream habitat, and even the surrounding watershed. An effective biomonitoring protocol must comprise attributes able to [...]

Published
2008

9. Kinetic studies of the reactions of nitrous acid scavengers

Author

Howes, K. R.

Subjects
541.39
Abstract

A kinetic, product and isotopic study of the reaction of hydrazine with nitrous acid has been carried out. At acidities greater than 0.5M, and with excess hydrazine present, hydrazoic acid is the major product. In the presence of excess nitrous acid, nitrogen and nitrous oxide are the only products, but nitrogen-15 tracer work showed that these are not formed via the nitrous acid-hydrazoic acid reaction. It is proposed that the nitrogen and nitrous oxide are formed via the double nitrosation of hydrazine. The first species formed on the reaction of hydrazine with nitrous acid is nitroso-hydrazine. This rapidly tautomerises forming a mixture of HN= N-buildrel + over N H2-OH and buildrel + over N H3-N = N-OH. In the presence of excess nitrous acid these species are nitrosated, the products formed decomposing to nitrogen and nitrous oxide. In the absence of excess nitrous acid these species decompose slowly forming hydrazoic acid. The species buildrel + over N H3-N = N-OH absorbs in the UV, with an absorbance maximum at 223 nm. The kinetics of its formation and decomposition have been studied by stopped-flow spectrophotometry. UV studies over a longer timescale revealed the presence of a species with an absorbance maximum at 230 nm, but this is thought to be only a very minor product. The rate of the reaction of nitrous acid with excess hydrazine was measured in nitric acid solutions of up to 15M in concentrations. A maximum rate is attained in 10M nitric acid. The rate falls at higher nitric acid concentrations due to the conversion of nitrous acid to dinitrogen tetroxide. A kinetic study was carried out on the reaction of hydrazoic acid with nitrous acid. The formation reaction of dinitrogen trioxide has an activation energy of 56 kJ mo1-1. The azide ion reacts with dinitrogen triozide at close to the encounter controlled rate. At high initial pH values, the pH rises as the reaction of nitrous acid with hydrazoic acid proceeds. A Gear numerical integration computer model can succesfully predict the variation of pH with time for this partially acidified system.

Published
1987

11. Development and preliminary testing of an online software system to facilitate assessment of accuracy and consistency in applying the Australasian Triage Scale

Author

Varndell, W, Hodge, A, Howes, K, Jeffers, A, Marquez-Hunt, N, and Hugman, A

Subjects
Technology Assessment, Biomedical, Research Design, Software Design, ComputingMilieux_PERSONALCOMPUTING, Humans, Reproducibility of Results, Triage, New South Wales, Emergency Service, Hospital, Retrospective Studies
Abstract

© 2018 College of Emergency Nursing Australasia Purpose: The aim of this project was to design and evaluate an online software system to facilitate the assessment of triage decision accuracy and consistency in applying the Australasian Triage Scale. Background: Triage is a critical component of emergency nursing practice, which affects patient access to emergency care. Accurate and consistent triage decisions are vital to ensuring patient safety, timely access to care and ED operation. Presently, there is no standard process to examine triage decisions, measure current performance and support department and individual performance development activities to improve patient safety and quality of emergency care. Method: An iterative design guided by a human factors development approach was used to develop a retrospective, focus-based analysis system to evaluate triage decision accuracy and consistency, and enable the exploration of service gaps and opportunities for practice change and professional development. Results: Triage decision accuracy and consistency, including areas for improvement are detectable and quantifiable. Findings generated may aid in departmental performance and professional development of triage nurses. Conclusion: This is the first system developed to assess decision accuracy and consistency in applying the Australasian Triage Scale. This paper has described the development and preliminary testing of a user-centred design process and implementation of a web-based system to evaluate triage decision accuracy and consistency.

Published
2018

12. Accounting for model error in strong-constraint 4DVar data\ud assimilation

Author

Howes, K. E., Fowler, Alison M., and Lawless, A. S.

Abstract

The strong constraint formulation of four-dimensional variational data assimilation (4DVar) assumes that the model used in the process perfectly describes the true dynamics of the system. However, this assumption often does not hold and the use of an erroneous model in strong constraint 4DVar can lead to a sub-optimal estimation of the initial conditions. We show how the presence of model error can be correctly accounted for in strong constraint 4D-Var by allowing for errors in both the observations and the model when considering the statistics of the innovation vector. We demonstrate that when these combined model error and observation error statistics are used in place of the standard observation error statistics in the strong constraint formulation of 4DVar, a statistically more accurate estimate of the initial state is obtained.\ud \ud The calculation of the combined model error and observation error statistics requires the specification of model error covariances, which in practice are often unknown. We present a method to estimate the combined statistics from innovation data that does not require explicit specification of the model error covariances. Numerical experiments using the linear advection equation and a simple nonlinear coupled model demonstrate the success of the new methods in reducing the error in the estimate of the initial state, even in the case when only the uncorrelated part of the model error is accounted for.

Published
2017

15. A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications for future practice

Author

Hodge, A, Hugman, A, Varndell, W, Howes, K, Hodge, A, Hugman, A, Varndell, W, and Howes, K

Abstract

Triage is a critical component in the delivery of time-sensitive emergency care. Decision-making and the activity of the triage nurse affect patient access to care and allocation of emergency department (ED) resources. It is important to be able to evaluate decision-making at triage to ensure patient safety, and to identify opportunities for professional and service development. At present, there is no standard approach to retrospective examination of triage decisions using the Australasian Triage Scale. The aim of this literature review is to identify the quality control strategies used in triage and the factors that appear to influence triage decisions in relation to the Australasian Triage Scale. © 2013 .

Published
2013

16. The review of the RoHS Directive: the Directive on the Restriction of Hazardous Substances currently excludes in vitro diagnostic (IVD) medical devices from its scope. That exemption is being reviewed. This article examines the implications of this for the IVD industry

Author

Howes, K.

Subjects
Diagnostic equipment (Medical) -- Equipment and supplies, Diagnostic equipment (Medical) -- Safety and security measures, Hazardous substances -- Laws, regulations and rules, Hazardous substances -- Usage, Medical societies -- Management, Company business management, Government regulation, Health, Law, European Union. European Commission -- Management
Published
2006

21. Trilateral tumors in four different lines of transgenic mice expressing SV40 T-antigen.

Author

Marcus, D M, Lasudry, Jacques, Carpenter, J L, Windle, J, Howes, K A, al-Ubaidi, M R, Baehr, W, Overbeek, P A, Font, R L, Albert, D M, Marcus, D M, Lasudry, Jacques, Carpenter, J L, Windle, J, Howes, K A, al-Ubaidi, M R, Baehr, W, Overbeek, P A, Font, R L, and Albert, D M

Abstract

A line of transgenic mice containing the simian virus (SV) 40 T-antigen (T-ag) gene driven by the beta-luteinizing hormone (BLH) promoter developed bilateral retinoblastoma and primitive neuroectodermal tumors (PNET) of the midbrain. Midbrain tumors arose from the subependymal layer of the cerebral aqueduct. Bilateral ocular and brain tumors ("trilateral") were found in three other SV40 T-ag transgenic murine lines containing different promoters (murine interphotoreceptor retinoid-binding protein (IRBP), human IRBP, and alpha A-crystallin). To gain insight into the regulatory mechanisms involved in central nervous system tumorigenesis, the authors examined brain tumors from four lines of SV40 T-ag mice with different promoters., Journal Article, info:eu-repo/semantics/published

Published
1996

25. Automated protein identification using MALDI mass spectrometry

Author

Gostick, D., primary, Brown, J., additional, Dobbins, A., additional, Kapp, E., additional, O'malley, R., additional, Langridge, J., additional, Howes, K., additional, Bordoli, R., additional, Slyker, T., additional, Randell, J., additional, Jacobson, A., additional, Larsen, E., additional, and Walker, D., additional

Published
2000
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29. Apoptosis or retinoblastoma: alternative fates of photoreceptors expressing the HPV-16 E7 gene in the presence or absence of p53.

Author

Howes, K A, Ransom, N, Papermaster, D S, Lasudry, Jacques, Albert, D M, Windle, J J, Howes, K A, Ransom, N, Papermaster, D S, Lasudry, Jacques, Albert, D M, and Windle, J J

Abstract

A transgenic mouse model for retinoblastoma was produced previously by directing SV40 T antigen expression to retinal photoreceptor cells using the promoter of the interstitial retinol-binding protein (IRBP) gene. This gene becomes active prior to the terminal differentiation of photoreceptors. Because T antigen-transforming activity is attributable, at least in part, to the inactivation of the retinoblastoma (pRb) and p53 tumor suppressor proteins, we addressed the role of p53 in the development of retinoblastoma in mice. Transgenic mice expressing HPV-16 E7 under the control of the IRBP promoter were generated to inactivate pRb in photoreceptors while leaving p53 intact. Rather than developing retinoblastomas, the retinas of these mice degenerate due to photoreceptor cell death at a time in development when photoreceptors are normally undergoing terminal differentiation. The dying cells exhibit the histological and ultrastructural features of apoptosis and contain fragmented DNA. p53 is required for the induction of apoptosis in this model, because mice expressing E7 in a p53 nullizygous background develop retinal tumors instead of undergoing retinal degeneration., Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., info:eu-repo/semantics/published

Published
1994

30. Photoreceptor cell tumors in transgenic mice.

Author

Howes, K A, Lasudry, Jacques, Albert, D M, Windle, J J, Howes, K A, Lasudry, Jacques, Albert, D M, and Windle, J J

Abstract

To produce transgenic mice that express the SV40 T-antigen oncogene specifically in photoreceptor cells, giving rise to retinoblastoma tumors of photoreceptor cell origin; to characterize the mice with regard to transgene expression and pathology and to characterize the resulting tumors histologically., Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., info:eu-repo/semantics/published

Published
1994

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